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Drug Delivery Dec 2022Aerosol therapy is used to deliver medical therapeutics directly to the airways to treat respiratory conditions. A potential consequence of this form of treatment is the...
Aerosol therapy is used to deliver medical therapeutics directly to the airways to treat respiratory conditions. A potential consequence of this form of treatment is the release of fugitive aerosols, both patient derived and medical, into the environment and the subsequent exposure of caregivers and bystanders to potential viral infections. This study examined the release of these fugitive aerosols during a standard aerosol therapy to a simulated adult patient. An aerosol holding chamber and mouthpiece were connected to a representative head model and breathing simulator. A combination of laser and Schlieren imaging was used to non-invasively visualize the release and dispersion of fugitive aerosol particles. Time-varying aerosol particle number concentrations and size distributions were measured with optical particle sizers at clinically relevant positions to the simulated patient. The influence of breathing pattern, normal and distressed, supplemental air flow, at 0.2 and 6 LPM, and the addition of a bacterial filter to the exhalation port of the mouthpiece were assessed. Images showed large quantities of fugitive aerosols emitted from the unfiltered mouthpiece. The images and particle counter data show that the addition of a bacterial filter limited the release of these fugitive aerosols, with the peak fugitive aerosol concentrations decreasing by 47.3-83.3%, depending on distance from the simulated patient. The addition of a bacterial filter to the mouthpiece significantly reduces the levels of fugitive aerosols emitted during a simulated aerosol therapy, ≤ .05, and would greatly aid in reducing healthcare worker and bystander exposure to potentially harmful fugitive aerosols.
Topics: Aerosols; COVID-19; Computer Simulation; Drug Delivery Systems; Equipment Design; Humans; Infection Control; Infectious Disease Transmission, Patient-to-Professional; Models, Biological; Nebulizers and Vaporizers; Particle Size; Respiratory Therapy; SARS-CoV-2
PubMed: 34962221
DOI: 10.1080/10717544.2021.2015482 -
Respiratory Care Mar 2021High-flow nasal cannula (HFNC) is an option for respiratory support in patients with acute hypoxic respiratory failure. To improve patient outcomes, reduce...
BACKGROUND
High-flow nasal cannula (HFNC) is an option for respiratory support in patients with acute hypoxic respiratory failure. To improve patient outcomes, reduce ICU-associated costs, and ease ICU bed availability, a multi-phased, comprehensive strategy was implemented to make HFNC available outside the ICU under the supervision of pulmonology or trauma providers in cooperation with a dedicated respiratory therapy team. The purpose of this study was to describe the education and implementation process for initiating HFNC therapy outside the ICU and to convey key patient demographics and outcomes from the implementation period.
METHODS
HFNC therapy was implemented at a tertiary hospital in the Midwest, with systematic roll-out to all in-patient floors over a 9-month period. Utilization of the therapy and patient outcomes were tracked to ensure safety and efficacy of the effort.
RESULTS
During the implementation period, 346 unique subjects met study inclusion criteria. Median (interquartile range) hospital length of stay was 8 d (4-12), and median duration of HFNC therapy was 44 h (18-90). Two thirds of subjects ( = 238) received the entire course of HFNC therapy outside the ICU, and more than half of subjects ( = 184) avoided the ICU for their entire hospitalization. Moreover, 6% of subjects in the study group escalated from HFNC to noninvasive ventilation, and 5% of subjects escalated from HFNC to mechanical ventilation.
CONCLUSIONS
A comprehensive implementation process and a robust therapy protocol were integral to initiating and managing HFNC in all hospital locations. Study findings indicate that patients with acute hypoxic respiratory failure can safely receive HFNC therapy outside the ICU with appropriate patient selection and staff education.
Topics: Cannula; Critical Care; Humans; Intensive Care Units; Noninvasive Ventilation; Oxygen Inhalation Therapy; Respiratory Insufficiency
PubMed: 32843505
DOI: 10.4187/respcare.07960 -
Revista Chilena de Pediatria Dec 2018Spinal muscular atrophy (SMA) is the first inherited cause of mortality in infants, with four subtypes: SMA0 prenatal onset, SMA1 babies less than 3 months non sitters,... (Review)
Review
Spinal muscular atrophy (SMA) is the first inherited cause of mortality in infants, with four subtypes: SMA0 prenatal onset, SMA1 babies less than 3 months non sitters, SMA2 sitters and SMA3 walkers. Pneumonia and respiratory insufficiency are the most severe complications. Informed parental de cisions are relevant. Respiratory management includes cough assistance, prevention of lung under development due to chest deformity, prompt treatment of respiratory infections, hypoventilation, swallow problems, gastro esophageal reflux and malnutrition. In view of the FDA and EMA approval of the nonsense oligonucleotides nusinersen, the first specific treatment for SMA and the future with gene therapy and others under development, we need to optimize preventive respiratory manage ment with the new standard of care.
Topics: Combined Modality Therapy; Humans; Infant; Respiratory Insufficiency; Respiratory Therapy; Spinal Muscular Atrophies of Childhood; Treatment Outcome
PubMed: 30725056
DOI: 10.4067/S0370-41062018005001208 -
Respiratory Care Jun 2015Aerosolized medications are routinely used for the treatment of critically ill patients. This paper reviews aerosol delivery devices with a focus on issues related to... (Review)
Review
Aerosolized medications are routinely used for the treatment of critically ill patients. This paper reviews aerosol delivery devices with a focus on issues related to their performance in pulmonary critical care. Factors affecting aerosol drug delivery to mechanically ventilated adults and spontaneously breathing patients with artificial airways are reviewed. Device selection, optimum device technique, and unmet medical needs of aerosol medicine in pulmonary critical care are also discussed.
Topics: Administration, Inhalation; Aerosols; Bronchodilator Agents; Critical Care; Equipment Design; Humans; Lung Diseases; Nebulizers and Vaporizers; Respiration, Artificial; Respiratory Therapy
PubMed: 26070580
DOI: 10.4187/respcare.03790 -
Respiratory Care Oct 2022Interprofessional Education (IPE) provides a framework for collaborative education between health care specialties to improve patient care. In 2010, the...
BACKGROUND
Interprofessional Education (IPE) provides a framework for collaborative education between health care specialties to improve patient care. In 2010, the Interprofessional Education Collaborative Expert Panel established the competencies of communication, ethics, roles and responsibilities, and teams and teamwork. Studies have assessed knowledge and attitudes about IPE in several allied health educational programs including respiratory therapy (RT).
METHODS
We compared RT faculty to athletic training (AT), nutrition (NT), occupational therapy (OT), physical therapy (PT), and dental hygiene (DH) faculty. Faculty were asked to rank the IPE competencies according to importance.
RESULTS
RT faculty ranked communication first, then teams and teamwork, roles and responsibilities, and last ethics. A Kruskal-Wallis Dwass-Steel-Chritchlow-Fligner pairwise analysis showed statically significant differences among allied health faculty rankings of IPE competencies. In communication, RT faculty responded statistically higher than AT ( < .001), DH < .001), NT < .001), and OT ( = .003). In ethics, RT faculty responded statistically lower than DH ( < .001), NT ( = .01), and PT ( < .001). In roles and responsibilities, RT faculty responded statistically higher than AT ( = .007) and OT ( < .001). In teamwork, RT faculty responded statistically higher than AT ( = .02), DH ( < .001), OT ( = .002), and PT ( < .001).
CONCLUSIONS
RT faculty who teach at different degree levels (associate's degree programs vs bachelor's and master's degree programs) had the same ranking of competencies, but they had a statistically significant difference for teamwork, with associate's degree faculty ranking teamwork lower than bachelor's and master's degree faculty.
Topics: Faculty; Humans; Interprofessional Education; Interprofessional Relations; Occupational Therapy; Respiratory Therapy
PubMed: 36041753
DOI: 10.4187/respcare.09791 -
Revista Brasileira de Terapia Intensiva 2013To analyze the outcomes of increased or decreased intracranial pressure and/or the decrease in cerebral perfusion pressure resulting from respiratory physiotherapy on... (Review)
Review
OBJECTIVE
To analyze the outcomes of increased or decreased intracranial pressure and/or the decrease in cerebral perfusion pressure resulting from respiratory physiotherapy on critically ill patients admitted to the intensive care unit.
METHODS
Through a systematic review of the literature, clinical trials published between 2002 and 2012 were selected. The search involved the LILACS, SciELO, MedLine and PEDro databases using the keywords "physical therapy", "physiotherapy", "respiratory therapy" and "randomized controlled trials" combined with the keyword "intracranial pressure".
RESULTS
In total, five studies, including a total of 164 patients between 25 and 65 years of age, reporting that respiratory physiotherapy maneuvers significantly increased intracranial pressure without changing the cerebral perfusion pressure were included. The articles addressed several techniques including vibration, vibrocompression, tapping, postural drainage, and the endotracheal aspiration maneuver. All patients required invasive mechanical ventilation.
CONCLUSION
Respiratory physiotherapy leads to increased intracranial pressure. Studies suggest that there are no short-term hemodynamic or respiratory repercussions or changes in the cerebral perfusion pressure. However, none of the studies evaluated the clinical outcomes or ensured the safety of the maneuvers.
Topics: Adult; Aged; Critical Illness; Humans; Intensive Care Units; Intracranial Hypertension; Intracranial Pressure; Middle Aged; Physical Therapy Modalities; Respiration, Artificial; Respiratory Therapy
PubMed: 24553515
DOI: 10.5935/0103-507X.20130055 -
European Respiratory Review : An... Mar 2018This review discusses the clinical challenges associated with ventilatory support and pharmacological interventions in patients with acute respiratory distress syndrome... (Review)
Review
This review discusses the clinical challenges associated with ventilatory support and pharmacological interventions in patients with acute respiratory distress syndrome (ARDS). In addition, it discusses current scientific challenges facing researchers when planning and performing trials of ventilatory support or pharmacological interventions in these patients.Noninvasive mechanical ventilation is used in some patients with ARDS. When intubated and mechanically ventilated, ARDS patients should be ventilated with low tidal volumes. A plateau pressure <30 cmHO is recommended in all patients. It is suggested that a plateau pressure <15 cmHO should be considered safe. Patient with moderate and severe ARDS should receive higher levels of positive end-expiratory pressure (PEEP). Rescue therapies include prone position and neuromuscular blocking agents. Extracorporeal support for decapneisation and oxygenation should only be considered when lung-protective ventilation is no longer possible, or in cases of refractory hypoxaemia, respectively. Tracheotomy is only recommended when prolonged mechanical ventilation is expected.Of all tested pharmacological interventions for ARDS, only treatment with steroids is considered to have benefit.Proper identification of phenotypes, known to respond differently to specific interventions, is increasingly considered important for clinical trials of interventions for ARDS. Such phenotypes could be defined based on clinical parameters, such as the arterial oxygen tension/inspiratory oxygen fraction ratio, but biological marker profiles could be more promising.
Topics: Clinical Decision-Making; Diffusion of Innovation; Forecasting; Health Services Research; Humans; Lung; Patient Selection; Pulmonary Medicine; Respiration, Artificial; Respiratory Distress Syndrome; Respiratory System Agents; Respiratory Therapy; Treatment Outcome
PubMed: 29367411
DOI: 10.1183/16000617.0107-2017 -
Respiratory Care Jan 2021
Topics: Hospitals; Humans; Nitric Oxide; Quality Improvement; Respiratory Therapy
PubMed: 33380504
DOI: 10.4187/respcare.08742 -
Respiratory Care Feb 2019Lung ultrasound is a point-of-care imaging tool that is routinely used in acute care medicine. Traditionally, radiology physicians were the primary practitioners of... (Review)
Review
Lung ultrasound is a point-of-care imaging tool that is routinely used in acute care medicine. Traditionally, radiology physicians were the primary practitioners of diagnostic ultrasound, but with the recognition of its importance in intensive care medicine, critical care physicians have also adopted this practice. Within the intensive care unit inter-professional team is the respiratory therapist, who participates actively in the care of ventilated patients. Their scope of responsibility is expanding with newer technologies being brought into clinical use on a regular basis. This review focuses on the scope and benefits of ultrasound training within respiratory care-related areas.
Topics: Allied Health Personnel; Critical Care; Humans; Lung; Patient Care Team; Point-of-Care Systems; Professional Role; Respiratory Therapy; Ultrasonography
PubMed: 30647101
DOI: 10.4187/respcare.06179 -
Respiratory Care Mar 2011
Topics: Aptitude; Clinical Competence; Education, Medical, Undergraduate; Humans; Respiratory Therapy; Students, Medical; Thinking
PubMed: 21396334
DOI: 10.4187/respcare.01245